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I dreaded the day when my mother would need to move into a nursing home. That day came, and a year and a half later, I enjoy her nursing home life on my visits—joining in Tai Chi or a round of mindgames, right alongside her. Her nursing home is so homey and hospitable that I wonder why more nursing homes aren’t like it.  

I put that question recently to the administrator of an East Bay nursing home that seems a lot like my mother’s—Salem Lutheran Home at 2361 East 29th St. in Oakland. A cluster of cozy dwellings atop a hill, Salem is a community made up of people at different stages of their elder years.  

Residents usually move into a cottage or apartment when they are still able to get around on their own. Then, as they begin to need help getting dressed, taking medication, or moving in and out of wheelchairs, they become part of the assisted-living program. They may still stay on in their own apartments with caregivers coming to them, and move to the main building only when they need more constant help.  

In the main building, residents showing signs of mild to moderate mental impairment live in clustered apartments and take part in programs meant to keep their memories going. Residents with more advanced dementia live in a different area, the Terrace. Residents who need round-the-clock skilled nursing care stay in the Care Center. 

Wherever they live, Salem residents are surrounded by art, music, gardens and animals. Following a model for eldercare called the Eden Alternative, Salem lets pets take up residence, as well as people. As I toured the main building with a staff member, I met the activities director’s Shih Tzu dog, who flopped down on the floor while the director joined a resident in impromptu song. In the Terrace, there’s a small aviary, and a bunny lives in the sunny activities room. On the patio just outside, residents sometimes water the flowerbeds (they sometimes water the concrete instead, I was told, but as all gardeners know, watering is relaxing whatever you’re watering). 

By the standards of pleasant living, Salem appears to be exemplary. By medical standards, as measured by state inspectors, the nursing care provided by Salem and its sister Oakland home, Mercy Retirement and Care Center, is outstanding. Both Salem and Mercy emerge from annual inspections with scores that couldn’t be better: no deficiencies for the past three years posted on www.medicare.com. 

How can Salem afford to offer such apparently high-quality nursing home care? 

For a start, Salem’s nursing care rates are higher than average for the East Bay. Monthly rates for the Terrace (for those with dementia) start at $4,750. Monthly rates for residents in the skilled nursing program start at $6,386. Rates for apartments and cottages are not as high, of course—studios start at $1,350 a month. Residents can rent month to month (with a one-time entry fee of $4,000). If they want to be assured of skilled nursing either at Salem or Mercy, however, they have to pay an entry fee that ranges from $20,000 to $150,000, depending on the size of their initial unit. Salem also takes a good look at would-be residents’ long-term assets. 

Although Salem needs to meet most expenses with income from residents, as a non-profit it has this advantage over for-profit eldercare: Salem administrators do not need to deal with stockholder or owner demands to make money.  

Salem’s nonprofit status, executive director Anita Ramlo told me, is one explanation for Salem’s ability to deliver good care. Because Salem is non-profit, and because Salem defines its mission in spiritual terms, it’s easier to talk with staff about their work as a calling, she said. That’s important because nurses and aides at Salem get about the same level of pay as nurses and aides elsewhere—certified nurses assistants (CNAs) without experience start at $12, licensed practical nurses at $25, registered nurses at $30 an hour. To attract good staff members and keep them, Salem needs to offer them something else. 

That something else, Ramlo said, is involvement in the running of the institution. Several Salem CNAs started out as housekeepers who took part in a program caring for the dying, then, with Salem helping out with the bills, went through training to become CNAs.  

To encourage CNAs to stay on, Salem has started training experienced aides to mentor newcomers. Salem also follows a collaborative model of decisionmaking, Ramlo said. “We’re small enough and we care enough about the staff that when we do mentor training, it doesn’t come across as a corporate program.”  

Experts agree that staff stability is a key element in providing good nursing home care: it’s hard on residents if their caregivers keep changing. At an awards dinner last spring, Arta Zygielbaum, the director of community relations who showed me around the main building, was surprised to see how long many of the staff members had worked at Salem—some received awards for 10-year and 25-year service. 

Volunteers supplement staff at Salem—children come in to work on the raised flowerbeds under the supervision of residents. A quilting group joins some of the residents in making quilts that are first displayed in the main residents’ dining room, then donated to Children’s Hospital. 

Showing me around, Zygielbaum shared her own thoughts about what makes Salem’s care unusual—for instance, the practice of delivering assisted-living care anywhere on the campus. While some retirement facilities rigorously separate patients who need help from those in “independent living” (the phrase often used, though not at Salem), Salem encourages mingling of residents in activities meant for everyone.  

As good as it looks and sounds, I’m sure there are downsides of life at Salem, as there are of life anywhere, especially when your body and mind are letting you down in ways you could hardly have imagined. But if I come to need the support of an institution in my elder years, I hope there’ll be one like Salem that I can afford. 

This, of course, is the fly in the ointment. America’s class divisions are sharp in nursing home care. Although skilled nursing patients at Salem who live long enough to deplete their own funds can go on Medi-Cal, Salem does not accept new residents already on Medi-Cal. Vast numbers of Americans who need nursing home care have to take what they can get—often bleak, understaffed wards where drugs replace secure environments and supervision. In one of the unpleasant ironies of American life, many frontline nursing home caregivers themselves would not be able to afford care like the care they’ve provided for so many others. 

There is no substitute for poneying up funds to improve the quality of publicly funded nursing home care, but funds alone can’t do the job. We need, too, a shift of attitude—a recognition that life in a nursing home is still life, and for nursing home residents like my mother, still very much life worth living.  

• To check the record of individual nursing homes: www.medicare.gov/NHCompare/Home.asp. 

• For a checklist of things to look for when considering a nursing home: www.medicare.gov/Nursing/Checklist.pdf. 

• For other useful information about eldercare, see the site for the California Association of  

• Homes and Services for the Aging: www.aging.org.  

• For more on the Eden Alternative: www.edenalt.com.  

• For other Elder Care Alliance communities: www.eldercarealliance.com.  

Salem staff photo 

Former elementary school teacher and Salem resident Martha Olson listens as first-grade students from Priscilla Hines Head Royce School read her a story. 

Former Oakland resident Carol Polsgrove lives in Bloomington, Indiana, where she teaches journalism at Indiana University.